Tag Archives for " refractive error "

Diagnosis of subtle refractive errors

Nearsightedness also called myopia is a condition where objects up close appear clearly, while objects far away appear blurred. In nearsightedness, light comes to concentrate before the retina after passing through the eye lens instead of on the retina. Clinically evaluated this common eyesight problem makes distant objects appear blurry, while close objects still appear sharp. Nearsightedness affects about 25 percent of all individuals in the United States, according to the National Eye Institute.

Farsightedness, likewise called hyperopia is also a common type of refractive error where distant objects might be seen much more clearly than objects that are near. However, people experience Farsightedness differently. Some people may not notice any type of problems with their near vision, especially when they are young. For people with significant farsightedness, vision can be blurry for objects at any type of distance, near or far.

Causes of Nearsightedness

The majority of nearsightedness cases result from an eyeball that's too long which prevents light from focusing directly on the retina (the "screen" at the back of the eye). Nearsightedness can be caused by a cornea (clear layer at the front of the eye) that's not shaped correctly. In fact, these two problems intercept light from focusing directly on the retina. Rather, light focuses in front of the retina, which makes distant objects appear blurry. Although researchers still don't know exactly why some people develop nearsightedness while others don't, it's possible that the problem may be genetic. If one or both of our parents is/are myopic, our chances of having the problem is higher those of a person whose parents aren't nearsighted.

Nearsightedness: Signs and symptoms

Nearsightedness might develop gradually or quickly. It usually initially occurs during childhood, and also can intensify as time goes on. Signs and symptoms of nearsightedness might consist of:

• Distant objects appearing blurry.

• The need to squint to see objects clearly.

• Headaches.

• Difficulty driving because of poor eyesight, especially at night during the night.

Identifying Nearsightedness

A complete eye examination by an optometrist can quickly detect nearsightedness. Commonly, eye-clinic vision tests will certainly be the first time a parent learns about a child’s nearsightedness. Sometimes parents or teachers will find nearsightedness after seeing a child squint in order to see distant objects. Grownups may start to realize that they have the problem when they have trouble watching movies, can't see distant objects clearly while driving, or participate in other activities that involve looking at far-away objects. If someone is having trouble seeing things that are far away, it's an excellent idea to get an eye examination. Even if he/she has no symptoms of nearsightedness, it's a good idea to get an eye examination around the time you turn 40.

Then, after that experts recommend getting an eye examination:

• Every 2 to 4 years between ages 40 and 54.

• Every 1 to 3 years between ages 55 and 64.

• Every 1 to 2 years beginning at age 65.


John who is a 10-year-old shy kid came to our clinic for a consultation reporting ‘blurry vision in one eye’. His mother searched online and learned about myopia, also known as nearsightedness. She had been told by a previous ophthalmologist that her son did not need to wear glasses since the kid had said he was ‘seeing well’ last year. However, in early February, John had started complaining his right eye was getting tired very easily and he could not concentrate well when he was reading or doing near work. John enjoys playing robotic games on the computer in his leisure time, and he said that he could no longer play as much as he used to without complaining of eye strain. His mom got concerned about the rapid change in his vision and the discomfort he experiences. As she did more in-depth research about myopia or nearsightedness, she found out about the unique ‘myopia control service’ offered by Khanna institute on Google.

Interestingly, neither parent has vision issues or need for glasses. Upon further evaluation, Dr. Khanna found that John had myopia in the right eye while his left eye displayed mild hyperopia and astigmatism. This condition is generally known as ‘anisometropia’ in which the shape and prescription is distinctively different in each eye. Given the fact that he was not prescribed with glasses last year, when they were checked, it was assumed that the level of myopia at that time might have been miniscule or considered ‘asymptomatic’. The onset of myopia often begins with a low amount of nearsightedness which can often go undetected. If left untreated for long, however, myopia can suddenly spike up and result in noticeable blurry vision for long distance vision. The case of John also raised the suspicion of ‘lazy eye’ or amblyopia due to the distinct anatomical and optical differences between the two eyes. Fortunately, he can be corrected to 20/20 perfect vision with no indication of lazy eye.

 Upon extensive educational talk and discussions with John and his mother, Dr. Khanna recommended an individualized myopia control treatment for him using K.I.D.S. (Keratometric Induced Dioptric Steepening) or overnight contact lens for the right eye to slow or halt myopia progression at that time. The untreated left eye would be monitored closely to ensure that it would not develop myopia in the long run.

 After the first day of overnight lens wear, John’s unaided vision in the right eye was 20/20 or perfect vision. He noticed that not only had his distance vision improved significantly after just one night of wearing the corrective contact lens in one eye, he also reported that he could read more comfortably with little stress or strain. His mother was amazed about the great result in such a short period of time, and the mother and kid were grateful to witness the shy kid who initially hid behind his mother’s back finally showing a grin and becoming more relaxed after knowing that he could see much better than before.

If you are concerned about your child’s myopia, please visit our website www.khannainstitute.com and schedule a complimentary evaluation with Dr. James Giraldi at our Westlake Village office..

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How to fix lazy Eye

How to Fix a Lazy Eye

How to Fix a Lazy Eye is a question often posed by young parents. Lazy Eye is a term used to define an eye that cannot see to its full potential. You may be aware normally an eye should see 20/20. That means that a person standing at 20 feet should see what a normal person sees at 20 feet. If a normal person can see at 40 feet what you see at 20 feet than your vision is 20/40. If after correction with glasses or contact lenses the vision does not improve to 20/20 than the eye is termed as Lazy. The medical nomenclature is Amblyopia.

Let us understand why an eye becomes lazy. The role of eye is transfer information from the surrounding universe to the brain. The eye condenses the light reflected from various objects on the macula. Electric signals generated are transferred to the brain by optic nerve. A specialized area of the brain called the occipital lobe converts these neuroelectrical signals into vision.

Any flaw in this process leads to an Amblyopic or Lazy Eye. There are three types of Lazy Eye.

The first kind is Neurological. This occurs when there is an obstruction in the neurological pathway or the brain. If the optic nerve is not developed, or the conduction pathways are malformed the light is not transmitted to the grey matter. Also the brain may be underdeveloped due to infections or genetic causes. This is the most challenging kind; currently this is not amenable to treatment.

The second kind is deprivation amblyopia. If the light is prevented from reaching the macula, it fails to stimulate the brain. There are various causes for this. Cornea may be opaque. There may be cataract in the lens. The jelly behind the lens may be fibrotic and hazy. The good news is that treatment can be provided. The earlier it is instituted the better the chance of fixing the lazy eye. Cataract procedure may have to be performed even before the baby is one year of age.

The third kind is refractive Amblyopia. The cause is nearsightedness, farsightedness or astigmatism. When the eye is very small or very large or has astigmatism significantly higher than the corresponding eye it is at risk of developing Amblyopia. Here the light reaches the macula and messages are delivered to the brain. But the messages are distorted. Since the brain keeps receiving information it has the best potential to recover.

How to Fix a Lazy Eye caused by Refractive Error

The way to do this is to fix the refractory error. The correct procedure would be influenced by the age and the refractive power. If the numbers are in the range of Lasik eye surgery this may be the simplest procedure. In such instances Lasik may even be performed on kids as young as six years. Sometimes an artificial lens may need to be implanted over the natural lens. If the person is above fifty years of age a presbyopic implant may be the best option.

In summary Refractive Amblyopia has the best chance of improving. This is possible in kids, young adults and even older individuals.

If you have any questions on how to fix a lazy eye please call (805) 230 2126